Real-Life Comparative Analysis of Robotic-Assisted Versus Laparoscopic Radical Prostatectomy in a Single Centre...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• The comparative advantage of robotic-assisted radical prostatectomy (RARP) over traditional laparoscopic radical prostatectomy (LRP) in treating prostate cancer requires further elucidation.
• Real-world data from homogeneous patient populations and single-surgeon expertise are crucial for evaluating surgical approach efficacy.

Purpose of the Study:

• To compare the oncological and functional outcomes of RARP versus LRP in a real-life setting.
• To analyze the impact of surgical approach on operating time, lymph node dissection, surgical margins, biochemical recurrence, and functional recovery in prostate cancer patients.

Main Methods:

• A prospective trial involving 444 non-metastatic prostate cancer patients undergoing radical prostatectomy (RP) via either RARP (160 cases) or LRP (284 cases).
• All procedures were performed by a single surgeon in a real-world clinical setting with homogeneous patient management criteria.
• Data collected included operating time, lymph node yield and positivity, surgical margin status, biochemical recurrence rates, and functional recovery assessments (urinary continence and erectile function).

Main Results:

• RARP demonstrated significantly shorter mean operating times (153.21 min vs. 173.33 min) and a higher mean number of lymph nodes removed during extended lymph node dissection (eLND) (19.83 vs. 15.16).
• No significant differences were observed in lymph node positivity (pN1) or surgical margin (SM) positivity between RARP and LRP groups.
• Biochemical recurrence (BCR) was significantly lower in the RARP group (7.5% vs. 14.4%), and RARP patients showed significantly better urinary continence recovery at 3 months post-surgery.

Conclusions:

• Robotic-assisted radical prostatectomy (RARP) offers significant advantages in reduced operating times, hospitalization, and catheterization duration compared to laparoscopic radical prostatectomy (LRP).
• While oncological outcomes regarding surgical margins and lymph node status show no definitive advantage for RARP, a trend towards reduced biochemical recurrence is noted.
• RARP facilitates a more rapid recovery of urinary continence within three months post-operation, although it does not confer significant advantages in erectile function recovery.